Hepatitis E outbreak in the health district of Bocaranga-Koui, Central African Republic, 2018-2019

• Published in: BMC infectious diseases 2024-02, Vol.24 (1), p.215-215, Article 215
• Main Authors: de Marguerite Nombot-Yazenguet, Marina Prisca, Doté, Joël Wilfried, Koyaweda, Giscard Wilfried, Zemingui-Bembete, Philippe Armand, Selekon, Benjamin, Vickos, Ulrich, Manirakiza, Alexandre, Nakoune, Emmanuel, Gouandjika-Vasilache, Ionela, Komas, Narcisse Patrice Joseph
• Format: Article
• Language: English
• Subjects: Age; Age groups; Antibodies; Bocaranga-Koui health district; Care and treatment; Central African Republic; Distribution; Drinking water; Enzyme-linked immunosorbent assay; Epidemics; Evaluation; Genotypes; Health aspects; Health promotion; Hepatitis; Hepatitis E; Hepatitis E outbreak; High-definition television; Hygiene; Immunoglobulin G; Immunoglobulin M; Infection; Infections; Medical research; Medicine, Experimental; Molecular biology; Molecular characterization; Outbreaks; Phylogenetics; Phylogeny; Polyethylene glycol; Polymerase chain reaction; Public health; Public health administration; Sanitation; Serology; Surveillance; Vector-borne diseases; Water pollution; Womens health; Yellow fever
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-024-09116-3

Hepatitis E virus (HEV) is a major public health disease causing large outbreaks and sporadic cases of acute hepatitis. We investigated an outbreak of HEV infection that occurred in September 2018 in the health district (HD) of Bocaranga-Koui, located in the northwestern part of Central African Republic (CAR). Blood samples were collected from 352 patients aged 0-85 years suspected to be infected with yellow fever (YF), according to the World Health Organization YF case definition. The notification forms from recorded cases were used. Water consumed in the HD were also collected. Human samples found negative for anti-YF IgM were then tested by ELISA for anti-HEV IgM and IgG antibodies. Positive anti-HEV (IgM and/or IgG) samples and collected water were then subjected to molecular biology tests using a real time RT-PCR assay, followed by a nested RT-PCR assay for sequencing and phylogenetic analysis. Of the 352 icterus patients included, anti-HEV IgM was found in 142 people (40.3%) and anti-HEV IgG in 175 (49.7%). Although HEV infection was detected in all age groups, there was a significant difference between the 0-10 age groups and others age groups (P = 0.001). Elevated levels of serum aminotransferase were observed in anti-HEV IgM-positive subjects. Phylogenetic analysis showed HEV genotype 1e in infected patients as well as in the contaminated water. This epidemic showed that CAR remains an HEV-endemic area. The genotype 1e strain was responsible for the HEV outbreak in Bocaranga-Koui HD. It is necessary to implement basic conditions of hygiene and sanitation to prevent further outbreaks of a HEV epidemics, to facilitate access to clean drinking water for the population, to launch intensive health education for basic hygiene measures, to sett up targeted hygiene promotion activities and, finally, to ensure that formal health care is available.